They Repeal, We Replace

Dogs love to chase cars. They make a lot of noise, puff out their chests and make a huge amount of bluster. But that’s all it is. Bluster. They wouldn’t know what to do with a car if they actually caught one, and they’d most likely get crushed underneath one of the wheels.

Such is the case with the Republican Party and the Affordable Care Act. The GOP has been loudly chasing the Obamacare car for about seven years. Some of those dogs actually wanted to catch the car, so furious they were with the sound and look of the car itself that they are willing to throw themselves at it to stop it. Many others, however, just saw how popular the other dogs were becoming, or were scared enough of one of them taking their place, and thus feigned a desire to catch the car.

Either way, they have it now.

Whether the members of the GOP actually want to repeal the ACA is immaterial. If they hope to win their next primary challenge, they have to follow through with it. They don’t have a choice. And here is where I differ from a lot of my likeminded progressives.

I say let them.

Now, I’m not saying we should embrace the GOP’s plans for replacement or even be happy that they’re repealing the ACA in the first place. But I am saying that they made this bed, and it might be time to let them fucking lie down in it.

The Republicans Have a Plan of Their Own. It’s Obamacare.
A little history here, but I’ll try to keep it brief. Progressives have been trying to enact some form of a national healthcare system since before there was even a Progressive Movement or even Socialism. Some government health services were set up in the wake of the Civil War and physicians organizations started lobbying for a government-run healthcare system, as other nations like Germany and England had started to do. Then came Teddy Roosevelt. And the Progressive Movement of the early 20th century. And then the Communists, who didn’t fare so well in America. And the Socialists, who did better than the Commies (thank Eugene Debs for your Social Security, y’all). Then FDR and the New Deal. Then the Civil Rights Movement. And the Great Society. And the Women’s Movement. And … where was I, again?

Oh yeah … a national healthcare system has been a central push for the American Progressive Movement in all of its various incarnations. It just hasn’t been THE central push. And when you expend political capital in government, you spend it on Priority #1. But then you generally end up compromising or losing out on Priorities #2 through, oh, infinity. That’s just the way it works. So, while a national, socialized form of healthcare insurance has always been a main part of progressivism, it has always been sacrificed for other goals that were more important at the time. For TR, that was trust busting and land management. For the Progressives, that was the income tax. For the early women’s movement, that was suffrage (yay!) and temperance (boo!). For FDR, it was Social Security and New Deal construction spending. For the early Sixties liberals, it was civil rights, which expended a lot of political capital leaving enough left over for only Medicare instead of a full national healthcare system.

By the Nixon era, however, our society had enjoyed a lot of the spoils of the victories of progressives, a topic I covered last time . Yes, there are always improvements to make and battles to win to make the world a more equitable place. But a lot of the big fights had been won, leaving a National Healthcare System (NHS) as the last big milestone. And conservatives could feel us breathing down their neck. So to head off the oncoming onslaught they felt was coming, the Republicans and Richard Nixon proposed their own version of an NHS, split into three categories (basically a three-part system analogous to employer provided, medicare, and medicaid), all government-funded and subsidized, that anyone could opt into. Pretty sure every liberal in America would take that plan if offered today, but the Democratic Party was sure it could do better. The Democratic Party, unfortunately, was wrong.

In the Seventies, the Ayn Rand wingnut wing of the Republican Party started to assert itself. This remnant of the libertarian Goldwater wing turned more insular and more devoted to its objectivism which turned into more of a modern day love of aristocracy. The “market is God and government is the Devil” wing started to take over, culminating with the election of Ronald Reagan in 1980, and it hasn’t let go since. If anything, that fundamentalist nonsense has only grown stronger.

And yet … and yet … the GOP still was afraid of the coming of an NHS, because it’s a very popular idea. So these market worshipers came up with a market-oriented plan as a counter-argument. Instead of government funding and collective bargaining it would rely on private companies and competitive marketplaces, and to make it affordable everyone would have to buy a private insurance plan from one of those marketplaces. Sound familiar? The first iteration of this was put forth by the ultraconservative Heritage Foundation in 1989. It was refined over the years and then made its primetime debut in Massachusetts in 2006 by then governor Mitt Romney.

Unfortunately for Republicans, Romneycare worked pretty well in Massachusetts. So as the Democrat failure after failure to try to pass an NHS got stale, many in the party turned to the Republican, Ayn Randian, Market Worshipping plan as an alternative. And the Affordable Care Act was born.

(Believe it or not, that is the brief version of the history here … )

So the Republicans won! Time to celebrate! Right? Or so you’d think. After fending off progressives for 150 years on an NHS, the progressives gave up and endorsed their plan. So were they happy? Uh, no. They took this policy victory and skewed it into a horrific “government takeover” of healthcare, complete with chimeric “death panels” and other nonsense. I can’t stress how ridiculous this situation is: REPEALING THEIR OWN IDEA BECAME THEIR RALLYING CALL.

So, Now They’ve Caught the Car …
Now, Republicans have a mouthful of car bumper and don’t know what to do with it. Since they’ve abandoned their own workable plan as “the work of Satan,” basically, they have to come up with something else. And they can’t. Because there isn’t another plan. Anything they come up with is either going to be a clone of the ACA … which their primary voters will hate … or be wildly insufficient, which will cause tens of millions to lose their healthcare insurance and the rest of us to pay more money for worse coverage … which general election voters will really hate.

They’re fucked. And as hard as it is, Democrats have to do everything in their power to not bail them out.

If the Republicans are going to turn this political turd into a political win, they need to set it up so that they fail in repealing and replacing it, but can blame the Democrats for the failure and thus make it theirs. The way they do this is by setting up a situation where the Democrats bail them out using the filibuster. If the Democrats use parliamentary shenanigans to delay and delay, then the Republicans can turn the tables in the public eye. So, I say, don’t filibuster. Don’t have to make it easy for the GOP to repeal the ACA. And then make it much, much harder for them to replace it. But putting the failure squarely on the shoulders of GOP legislators is paramount.

If they can avoid making the hard choice to vote for repeal and then the even harder choice to vote for an inferior replacement, Mitch McConnell is smart enough to take that. So what do we do instead?

1. Make sure everyone understands the consequences. This is most important for insurance companies and pharmaceutical companies. The Democrats need to publicly voice, in absolutely no uncertain terms, that if the ACA is repealed, that they will not be reinstating it. It was a lot of political pain and sweat to enact it in the first place, all for a conservative plan that progressives never wanted in the first place. No! If insurance companies don’t stand up and fight to preserve it now, they won’t get it back. Next time, it’ll be an NHS.

2. Come up with a real, reasonable workable national plan. Not the fairy tale bullshit that Bernie Sanders was touting on the campaign trail. No premium, no copay, no coinsurance, no fucking way. Sure it might work in Denmark, but so does a 51% tax rate, and neither of those fucking things are going to fly here. We need a decent base NHS plan that we can afford but then build on top of in the future. Something like: For a premium of $100 per month per adult, you get an NHS plan with a $2,500 deductible and 90% coinsurance. One preventative physical and mental health visit are 100% covered per calendar year, brand name vs. generic drugs are covered similar to most plans do now, and set fees are set up for urgent care and ER visits. There needs to be real out of pocket spending to keep everyone honest and to balance the costs between individuals and the government. We could then layer over other plans for the elderly (a la Medicare) and lower income (a la Medicaid), assuming we find the funding for it. (I’ll lay out more details for why I think this is workable in a future column.)

3. Promote that plan like crazy. Keep it simple like that. How easy is “Hey, for $100 a month, I have a simple plan I can use anywhere?” While the Republicans will be doing cartwheels trying to pull off unworkable plans and make them look better than they are, the Democrats would have a simple, affordable alternative that everyone can understand.

4. Keep it simple. Democrats need to avoid getting too far in the weeds here. Being better at policy is actually one of their biggest downfalls. People don’t mind big government. They don’t. What they hate is secretive, confusing government. Nothing is bigger than Social Security. But it’s simple, so everyone loves it. An NHS needs to be the same, even if people pay a little bit more out of their pockets for it.

5. And if nothing changes, your Public Option is already done! Think about it, if this idea is actually good enough to get the GOP to back down from repeal, then this NHS plan would be done and ready to be rolled out as a public option run by the Medicare system.

So Get Ready, Because Here Comes the Shit Storm.
A lot of people are lulling themselves into the foolish thought that the Republicans and President Donald Trump will see the light and decide to not repeal the ACA after all. A light will shine down from the heavens and they will realize that they’ve been fools and …

Nah. C’mon.

The GOP has been telling their constituents that Obamacare is the worst, most insidious government program ever invented. They have no choice now but to repeal it. And the shit storm that will follow their foolish fate could be their undoing. If they replace it with an Obamacare clone, they’ll lose their primaries to right wing zealots even worse than they are. If the Obamacare replacement is horrible, expensive, and helps no one, they’ll be poised to lose in the general election.

But the Democrats need to be ready to pounce. It requires being prepared. It requires having an NHS replacement plan of your own ready. It requires that plan to be easy to understand and palatable (if not outright desirable) to all voters. And, most importantly, it requires resisting the urge to save the Republicans from themselves. They made this pile of shit, so it’s time to let them step in it.